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Children affected by the Chernobyl accident

Medical relief for children affected by the Chernobyl accident through the development and implementation of health telematics

The World Health Organization (WHO) and Sasakawa Memorial Health Foundation (SMHF) have been carrying out a number of projects aimed at humanitarian assistance in Belarus, Russia and Ukraine, the countries most affected by the Chernobyl accident, to alleviate medical consequences of this disaster. Medical examinations of about 210 000 children performed within the framework of the WHO International Programme on the Health Effects of the Chernobyl Accident (IPHECA) and Chernobyl Sasakawa Project in the three countries since 1991, have shown a significant increase in the incidence of childhood thyroid diseases including thyroid cancer. In particular, evident for the Gomel region of Belarus, thyroid cancer incidence is about 100 times higher than before the accident.

WHO and SMHF consider that one of the important tasks in the continuation of humanitarian assistance to countries affected by the Chernobyl accident is the strengthening of medical care facilities, mainly in the areas most radio-contaminated and with the largest number of childhood thyroid cancer patients. In this context, both Organizations in co-operation with the Ministry of Health of the Republic of Belarus have initiated a project in order to improve diagnosis of thyroid diseases and follow up of patients treated for thyroid cancer, in particular in Gomel region of Belarus.

The telemedicine, tele-education and telepathology activities will be completed in Minsk and Gomel in December 2002. In future the project may be extended to other areas of Belerus, and to the Russian Federation and Ukraine.

Project Description

Introduction

The World Health Assembly in its Resolution 49.22 (25 May 1996) urged the Member States to participate actively in and to provide further support for the implementation of the International Programme on the Health Effects of the Chernobyl Accident. It also requested the Director-General to give emphasis to the monitoring and mitigation of long-term health effects in highly exposed groups including children.

The World Health Organization and Sasakawa Memorial Health Foundation have been carrying out a number of projects aimed at humanitarian assistance in Belarus, Russia and Ukraine, the countries most affected by the Chernobyl accident, to alleviate medical consequences of this disaster. Medical examinations of about 210 000 children performed within the framework of the WHO International Programme on the Health Effects of the Chernobyl Accident (IPHECA) and Chernobyl Sasakawa Project in the three countries since 1991, have shown a significant increase in the incidence of childhood thyroid diseases including thyroid cancer. It is, in particular, evident for the Gomel region, Belarus, where thyroid cancer incidence is 100 times higher than before the accident.

WHO and SMHF consider that one of the important tasks in the continuation of humanitarian assistance to countries affected by the Chernobyl accident is the strengthening of medical care facilities, mainly in the areas most radio-contaminated and with the largest number of childhood thyroid cancer patients. In this context, both Organizations are willing to initiate a project in order to improve diagnosis of thyroid diseases and follow up of patients treated for thyroid cancer.

Based on preliminary consultations with the Ministry of Health of Belarus, and taking into account the dramatic increase of the thyroid pathology in this country, especially in the Gomel region, it is envisaged that the project will start in Belarus and involve specialized centres of thyroid pathology in Gomel and Minsk. In future, the project may be extended to the Russian Federation and Ukraine.

Goals and objectives

This project proposal has been developed on the basis of the Memorandum of Understanding between the World Health Organization (WHO) and Sasakawa Memorial Health Foundation (SMHF) signed in the presence of the Ministry of Health of Belarus on 22 May 1998.

In cooperation with the Belarus Ministry of Health, to continue efforts aimed at the improvement of early diagnosis and treatment of children affected by the Chernobyl accident.

Development of a remote-area medical assistance system by establishing health telematics communication with the possible use of satellite telecommunication between the Gomel Specialized Dispensary and a relevant WHO Collaborating Centre, such as the WHO Collaborating Centre for Research on Thyroid Diseases in Nagasaki University, School of Medicine.

Setting up the project coordinating centre in a relevant medical institution in Minsk and the development of telematics communication links between Gomel and Minsk centres in order to provide the quality of diagnosis on the basis of better exchange of medical information within and outside Belarus of radio-exposed persons.

The development of telepathology as an integral part of a diagnostic process and follow-up of children with thyroid diseases; establishment of a project clinical database.

Background

These are as follows:

A. Narrative

Analysis of the health care system in Belarus has shown that there are still many gaps and unresolved problems. For example, they include uneven geographical distribution of health care resources throughout the country, including facilities and manpower; inadequate access to health care in the radionuclide-contaminated areas because of remoteness of many residents from medical centres; inadequacy of modern communication facilities between primary, regional and national health care facilities; insufficient possibilities for training and education of local medical staff; non-effectiveness of medicines and lack of information about new achievements in medical practice, in particular, at the primary health care level.

Experts from WHO and SMHF discussed various possibilities for expanding collaboration between medical centres in Belarus and WHO collaborating centres specializing in diagnosis, treatment and follow up of patients suffering from thyroid diseases. This collaboration may provide valuable assistance to national health authorities in improving medical care for residents of radionuclide-contaminated territories through obtaining expert consultations, information and exchange of experience, education of medical staff, recommendations for more effective implementation in practice of new medicaments, methods of treatment and rehabilitation. One of the rational approaches is the appropriate use of health telematics. This is in line with recommendations of the WHO Group Consultation on Health Telematics Policy in support of the renewed Health-for All Strategy in the 21st century (Geneva, 11 to 16 December, 1997).

Considering health telematics opportunities for health care systems and taking into account the recommendation of the WHO Group Consultation to “Explore and promote the best use of health telematics in public health: e.g. in disease surveillance, prevention and control, health education, health promotion, health systems and service development, ... environmental health, with particular attention to .... specific population groups that are most in need or underserved”, WHO and SMHF, after consultation with the Ministry of HealthBelarus, agreed to combine their efforts in the development of health telematics in Belarus focusing its implementation on the improvement of humanitarian medical relief actions for children affected by the Chernobyl accident. Both Organisations consider health telematics being an integral component of the project.

B. Relationship with other work planned by WHO

The proposed work is complementary to the International Programme on the Health Effects of the Chernobyl Accident (IPHECA) coordinated by WHO. Further, the health telematics network and outcomes of the project may be linked in future with the project “International cooperation for post Chernobyl NIS thyroid tissue, blood, nucleic acid banks and related data” initiated by EC, WHO, USA NCI and SMHF as well as with WHO Collaborating Centres for diagnosis, treatment and follow-up of thyroid diseases which have been established within the framework of the IPHECA International Thyroid Project (ITP).